Insomnia Explained Clearly - Causes, Pathophysiology & Treatment

Insomnia Explained Clearly - Causes, Pathophysiology & Treatment

Crowd welcome to another MedCramlecture in the next set of lectures, we're going to talk about insomnia, whatcauses it. What are the different diseases that can cause it and how tomanage it, and I would say that, even though I am a sleep specialist, some ofthe recommendations, I'm going to be giving are not for everybodyso. You need to make sure that you follow up with your own physician, but let's gothrough insomnia. The first thing we got to do is talk about what happens. Withnormal aging. There are different stages of sleep. There is stage one what we termn one there's stage two and there stage three couple of other stages as wellthere is REM, sleep which I'm sure you've heard about. Generally speaking, whathappens over the period of a night is someone starts out wake. They go downinto very transient. Sleep phase called stage one, and then they go down to stagetwo and eventually go down into stage three, where they stay until they go intoREM sleep which I'll code here as very dark.

Then they come out of that and theygo right back up to the beginning of stage one and they repeat the same thingagain. Now, as this occurs throughout the night, this REM sleep gets longer andlonger until actually most of the REM sleep is towards the end of the nightthese deep stages of sleep. So stage three are usually longer towards thebeginning of sleep, so something that we see here in normal sleep is that stage: 3is concentrated toward the beginning of the night and REM sleep is concentratedmore towards the end of the night. Both of these are very restful. This isphysically restful stage 3 sleep. This is where growth hormone is produced and REMsleep is very mentally restorative, so both of these are very veryimportant and unfortunately, as we get older, we see a reduction in both ofthese types of sleep and an increase in this very sort of bland end to type ofsleep, Which really is is more of a light sleep, so this is what we see with innormal aging

Now! Most of these changes! Occur. By the. Age of, 40! Or 50 years! Ofage and! Sleep remains! Pretty constant from the, age of; 60 to; 90 There! Is oneexception! And that, sleep efficiency, so what, is sleep, Efficiency sleepefficiency! Is simply! The! Amount! Of time! Of sleep! Divided! By the amount of timein bed and that steadily decreases from about 95 percent down to about 80percent in general, as one approaches 80 years of age. So what happens when youapproach middle age there's a number of things that occur normally there'sincreased awakenings, so you're waking up more in the middle of the night, there'sa Razzles and there's more stage shifts

This is the stage as I was talking aboutbefore. You also see a decrease in stage 3 and you also see a decrease in REMsleep, as I mentioned before, you get a decrease in sleep efficiency and as youreach middle age. There is more of what we call a phase advancement. What do Imean by phase advancement with phase advancement you're going to be gettingup earlier, so basically getting up from bed earlierand going to bed earlier? The interesting thing, however, is thatdespite. All of these things you're a little bit more resistant to sleepdeprivation or to the effects of sleep deprivation. What I mean by this is thatlet's say as a teenager. If you missed four or five hours of sleep, it wouldn'taffect you as much as if you were older and you missed four or five hours, ofsleep you'd be able to perform a little better, which is kind of paradoxical fromwhat. You would think now in terms of disease in actual disease, insomnia goesup as we get older, no surprise there

If we look at a study of 18, the 34 yearolds now there's about 14 % incidence of insomnia from the age of 35 to 49 theincidence is about 15 %, so it remains pretty stable. However, when we get to 50to 64 years of age, we hit about a 20 % incidencehere's the key, though from 65 to 79 years of age that jumps up to 25 % thisis. This is a pretty astounding figure when you realize that a quarter of thepopulation of retirement age has a problem with insomnia and insomnia is apretty generic term I mean if we could use a number of different words todescribe it some about 19 % of people. Wake up too early, another 19 % would describe troublefalling asleep. Twenty-Five percent have daytime napping 29 %, basically come right out and justsay they've got insomnia and then, if you look at both initiating and maintainingsleep we're looking at 43 percent of older adults

So these are people whohave a mean age of 74 years of age, of those people. These are what they'recomplaining about, and 43 percent have problems with initiation and maintainingboth. Now this is by no means a geriatric diagnosis. There are many of young peopleand middle-aged people who have this problem now in terms of the differentcauses of insomnia. Let'S say we got rid of all of the easy causes of insomniafor instance drinking too much caffeine or some of these things. If we were tobreak it down. What would be the breakdown of insomnia in terms of causewell? It turns out the biggest reason for people to have insomnia, so 35 percent ofpeople, who have insomnia, have some sort of psychiatric illness and what I meanby, that is depression. So you've got to know that in terms of treatment becauseif, you don't treat the depression. The insomnia is not going to get better nexton. The list about 15 percent have what we call psycho physiologic or what we call performance anxiety. Whatdo I mean by that, have you ever been in the kitchen or in the living room or thefamily room felt, really tired and then, as soon as you went into the bedroom, youjust could not fall asleep